Browsing by Author "Kutyifa, Valentina"

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    An International Multicenter Evaluation of Type 5 Long QT Syndrome: A Low Penetrant Primary Arrhythmic Condition.
    (Circulation, 2020-02) Roberts, Jason D; Asaki, S Yukiko; Mazzanti, Andrea; Bos, J Martijn; Tuleta, Izabela; Muir, Alison R; Crotti, Lia; Krahn, Andrew D; Kutyifa, Valentina; Shoemaker, M Benjamin; Johnsrude, Christopher L; Aiba, Takeshi; Marcondes, Luciana; Baban, Anwar; Udupa, Sharmila; Dechert, Brynn; Fischbach, Peter; Knight, Linda M; Vittinghoff, Eric; Kukavica, Deni; Stallmeyer, Birgit; Giudicessi, John R; Spazzolini, Carla; Shimamoto, Keiko; Tadros, Rafik; Cadrin-Tourigny, Julia; Duff, Henry J; Simpson, Christopher S; Roston, Thomas M; Wijeyeratne, Yanushi D; El Hajjaji, Imane; Yousif, Maisoon D; Gula, Lorne J; Leong-Sit, Peter; Chavali, Nikhil; Landstrom, Andrew P; Marcus, Gregory M; Dittmann, Sven; Wilde, Arthur AM; Behr, Elijah R; Tfelt-Hansen, Jacob; Scheinman, Melvin M; Perez, Marco V; Kaski, Juan Pablo; Gow, Robert M; Drago, Fabrizio; Aziz, Peter F; Abrams, Dominic J; Gollob, Michael H; Skinner, Jonathan R; Shimizu, Wataru; Kaufman, Elizabeth S; Roden, Dan M; Zareba, Wojciech; Schwartz, Peter J; Schulze-Bahr, Eric; Etheridge, Susan P; Priori, Silvia G; Ackerman, Michael J
    BACKGROUND:Insight into type 5 long QT syndrome (LQT5) has been limited to case reports and small family series. Improved understanding of the clinical phenotype and genetic features associated with rare KCNE1 variants implicated in LQT5 was sought through an international multicenter collaboration. METHODS:Patients with either presumed autosomal dominant LQT5 (N = 229) or the recessive Type 2 Jervell and Lange-Nielsen syndrome (N = 19) were enrolled from 22 genetic arrhythmia clinics and 4 registries from 9 countries. KCNE1 variants were evaluated for ECG penetrance (defined as QTc >460 ms on presenting ECG) and genotype-phenotype segregation. Multivariable Cox regression was used to compare the associations between clinical and genetic variables with a composite primary outcome of definite arrhythmic events, including appropriate implantable cardioverter-defibrillator shocks, aborted cardiac arrest, and sudden cardiac death. RESULTS:A total of 32 distinct KCNE1 rare variants were identified in 89 probands and 140 genotype positive family members with presumed LQT5 and an additional 19 Type 2 Jervell and Lange-Nielsen syndrome patients. Among presumed LQT5 patients, the mean QTc on presenting ECG was significantly longer in probands (476.9±38.6 ms) compared with genotype positive family members (441.8±30.9 ms, P<0.001). ECG penetrance for heterozygous genotype positive family members was 20.7% (29/140). A definite arrhythmic event was experienced in 16.9% (15/89) of heterozygous probands in comparison with 1.4% (2/140) of family members (adjusted hazard ratio [HR] 11.6 [95% CI, 2.6-52.2]; P=0.001). Event incidence did not differ significantly for Type 2 Jervell and Lange-Nielsen syndrome patients relative to the overall heterozygous cohort (10.5% [2/19]; HR 1.7 [95% CI, 0.3-10.8], P=0.590). The cumulative prevalence of the 32 KCNE1 variants in the Genome Aggregation Database, which is a human database of exome and genome sequencing data from now over 140 000 individuals, was 238-fold greater than the anticipated prevalence of all LQT5 combined (0.238% vs 0.001%). CONCLUSIONS:The present study suggests that putative/confirmed loss-of-function KCNE1 variants predispose to QT prolongation, however, the low ECG penetrance observed suggests they do not manifest clinically in the majority of individuals, aligning with the mild phenotype observed for Type 2 Jervell and Lange-Nielsen syndrome patients.
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    Race and Sex Differences in QRS Interval and Associated Outcome Among Patients with Left Ventricular Systolic Dysfunction.
    (J Am Heart Assoc, 2017-03-20) Randolph, Tiffany C; Broderick, Samuel; Shaw, Linda K; Chiswell, Karen; Mentz, Robert J; Kutyifa, Valentina; Velazquez, Eric J; Gilliam, Francis R; Thomas, Kevin L
    BACKGROUND: Prolonged QRS duration is associated with increased mortality among heart failure patients, but race or sex differences in QRS duration and associated effect on outcomes are unknown. METHODS AND RESULTS: We investigated QRS duration and morphology among 2463 black and white patients with heart failure and left ventricular ejection fraction ≤35% who underwent coronary angiography and 12-lead electrocardiography at Duke University Hospital from 1995 through 2011. We used multivariable Cox regression models to assess the relationship between QRS duration and all-cause mortality and investigate race-QRS and sex-QRS duration interaction. Median QRS duration was 105 ms (interquartile range [IQR], 92-132) with variation by race and sex (P<0.001). QRS duration was longest in white men (111 ms; IQR, 98-139) followed by white women (108 ms; IQR, 92-140), black men (100 ms; IQR, 91-120), and black women (94 ms; IQR, 86-118). Left bundle branch block was more common in women than men (24% vs 14%) and in white (21%) versus black individuals (12%). In black patients, there was a 16% increase in risk of mortality for every 10 ms increase in QRS duration up to 112 ms (hazard ratio, 1.16; 95% CI, 1.07, 1.25) that was not present among white patients (interaction, P=0.06). CONCLUSIONS: Black individuals with heart failure had a shorter QRS duration and more often had non-left bundle branch block morphology than white patients. Women had left bundle branch block more commonly than men. Among black patients, modest QRS prolongation was associated with increased mortality.